Healthcare Provider Details

I. General information

NPI: 1184142762
Provider Name (Legal Business Name): MARIETA S CARAGAY,M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 09/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 WILKENS AVE STE 102
BALTIMORE MD
21229-5204
US

IV. Provider business mailing address

706 IVY HILL RD
HUNT VALLEY MD
21030-1509
US

V. Phone/Fax

Practice location:
  • Phone: 410-355-2822
  • Fax:
Mailing address:
  • Phone: 410-336-9175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIETA CARAGAY
Title or Position: PHYSICIAN
Credential:
Phone: 410-355-2822